What is Degenerative Spondylolisthesis?
Degenerative spondylolisthesis is a spinal condition where one vertebra slips forward over the one below it due to age-related changes in the spine. It most commonly affects the lower lumbar spine, especially at L4-L5, and typically occurs in older adults, especially women.
What are the Causes and Risk Factors of Degenerative Spondylolisthesis?
Degenerative spondylolisthesis is primarily caused by age-related changes in the spine, such as degeneration of the intervertebral discs and facet joints, which lead to instability and forward slippage of one vertebra over another. Risk factors include advancing age, particularly in individuals over 50, and a higher prevalence in women, especially after menopause, due to hormonal and anatomical differences. Other contributing factors include genetic predisposition, obesity, and repetitive stress on the spine from physical labour or frequent bending and twisting. Ligament laxity and arthritis also play a significant role by weakening the spinal support structures, making the spine more susceptible to slippage.
What are the Symptoms of Degenerative Spondylolisthesis?
The common symptoms of degenerative spondylolisthesis include the following:
- Low back pain
- Leg pain or sciatica
- Numbness or tingling
- Postural changes
- Muscle weakness
- Stiffness and decreased mobility
- Neurogenic claudication (pain/numbness in legs with walking or standing, relieved by sitting or bending forward)
How is Degenerative Spondylolisthesis Diagnosed?
Degenerative spondylolisthesis is diagnosed through a combination of clinical assessment and imaging studies. The process begins with a detailed medical history and physical examination to evaluate symptoms such as back pain, leg pain, and neurological deficits like numbness or weakness. Imaging plays a key role, with standing lateral X-rays used to detect and grade the forward slippage of one vertebra over another. An MRI is often performed to assess disc degeneration, nerve compression, and spinal canal narrowing. In some cases, a CT scan may be used to provide a more detailed view of the bone structures, especially if surgery is being considered.
How is Degenerative Spondylolisthesis Treated?
Degenerative spondylolisthesis is treated based on the severity of symptoms. Non-surgical treatments are usually tried first and may include physical therapy, anti-inflammatory medications (NSAIDs), activity modification, and epidural steroid injections to relieve pain and inflammation. If symptoms persist or there is significant nerve compression or spinal instability, surgical treatment may be recommended. Surgery typically involves spinal decompression to relieve pressure on the nerves, often combined with spinal fusion to stabilise the affected segment. Minimally invasive surgical options may also be considered in suitable patients.
